This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Saturday, 3 October 2009

Visitors from Hell

I found this on the net and thought it was funny.

Top Ten Visitors from Hades:

10. The man who snuck in three cats to visit his asthmatic mother.

9. The visitor who ate all his father's food, then rang the nurse to say that the patient was still hungry and needed another tray.

8. The wife who asked you to take her stroked-out husband to the bathroom whenever SHE really was the one who had to go.

7. The son who emptied his mother's colostomy bag into the wastebasket.

6. The husband who fell asleep in the patient's bed while his wife was in the bathroom.

5. The wife who discontinued her husband's central line herself, because “John likes to sleep on his right side.”

4. The 80 year-old daughter of the 98 year old man, who kept turning off her father's continuous gastric feeding because, "He never eats this much a home."

3. The children of one patient who insisted upon using their mother's portable IPPB machine as a scooter in the hallway.

2. The husband who kept sneaking in chocolates for his newly diagnosed diabetic wife.

1. The man who never actually visited his mother, but called twelve times every shift to criticize the nurses, the doctors, the food, and anything else that came to mind.

Here are some of my own additions to the above list: (details changed as confidentiality will not be breached in any way shape or form on this blog. Hospital patients and visitors up and down the country pull these stunts all the time every day. You do not recognise anyone here)

The man who thought that the only reason the nurses put a catheter into his wife was because they are "lazy" so he pulled it out with the balloon inflated and didn't tell anyone. Not only was there trauma but she went into severe retention.

The woman who brought litres of pop into her partner who was in severe CCF and on a fluid restriction. After we explained why this is a bad idea she continued to do it and they just hid the bottles.

The husband who shoved food into his wife's trach because he felt that we were starving her to death.

The daughter who messed with the pump and ran her fathers IV fluids in super fast because she thought that we were dehydrating him to death. The fluids that were hanging had potassium.

The man who punched his demented mother and called her a stupid bitch because she did not recognise him and peed on the floor. Prior to this he had accused the staff of being abusive towards her because the tea trolley girl gave his mum tea with sweetener rather than sugar. She was diabetic.

Anyone who doesn't understand that people with end state dementia do not want to eat and will not eat no matter how hard you try and accuses a nurse who is running between 15 of these patients as well as doing a 100 other things whilst being constantly interrupted of "starving gran to death".

The family who feeds their stroked out gran with no swallow reflex despite the staff telling them that this is dangerous. Then they want to sue the hospital when gran dies of aspiration pneumonia. She got pneumonia from the nurses starving her don't you know. Yep. It doesn't matter how many times you try and explain it, they just don't get it. It's actually very sad.

The visitor who takes the patient with fibrosis in the next bed off of her 0xygen and then places it on his gran who is being treated for a Urinary infection instead because "why should the lady in the next bed get something that my gran doesn't". Never mind that gran has o2 sats of 100% on air anyway and the lady in the next bed is now cyanotic. Our beds are very close together.

The visitors who call the asthmatic patient in the bed next to their auntie "a fucking noisy bitch" because she needed to be nebulised at night. Of course the poor asthmatic patient overheard them complain and was in tears apologising because of her breathing treatments being so noisy. The poor thing. I gave those visitors hell.

Management won't do anything about any of this and if we say anything to patients and visitors we just get flipped off. Hospital chiefs want to promote the customer is always right image, much to the detriment of the nurse's sanity and patient care.

I so wish we had visiting hours. Working in the US you'll have "visitors" that come in at 7am and don't leave till 10pm. No, they're not visiting anyone who is dying they're just snooping and scoring free food, soap and water.

Yes the drug round ring causes me to fly into a rage. Our phone rings constantly at mealtime and it is a fair bit of a walk from the area where the patients are. Do they honestly think that we have someone to are for the patients AND answer the phone?

They put complaints in when no one answers the phone and then they complain when the patients aren't cared for. Most of the phone calls are a big fat waste of time since we cannot give any kind of infor whatsoever to anyone who is not identified as the NOK on the admission form.

We had so and so's neighbour from 20 years ago ringing every hour because " i like to see how she is".

Then they get abusive when you won't give test results over the phone. You shouldn't be asking or getting test results from a nurse anyway. What if that CT scan showed cancer everywhere?

Speaking as a visitor myself, I cannot understand how you keep your patience with them. I tried to do the right thing, not have too many family visiting at once, keep the noise down etc only to see a pack of chavs descend on a ward and cause utter chaos.

Some of the ones I spotted should have been steam-cleaned before they were allowed to come in. No wonder there are hospital infections...

They were constantly shouting into their mobile phones, eating, burping, wiping their noses on their sleeves, eyeing up patient's lockers and couldn't sit still for more than 2 mins without shouting "Why dunt they have smokin' rooms, I gotta go all the way out for a fuckin' fag, ennoi?"

The nurses haven't got time to be security guards, they were hassled enough as it is.

I have worked with visitors who have pinned me up against the wall , have spat at me, have been found curled up with their partner in their bed (who had a bit of abdo pain aged 20...)have given their relatives fags to smoke..and a lighter (in the bed...with Oxygen running....)I love the geneal public. Most of them to be fair are OK, and usually a bit scared, but there are those who I would gladly fling by the scruff of the neck onto the pavement.

I WISH I COULD FIND A HOSPITAL TO WORK AT WHERE ADMINISTRATION REALLY CARES ABOUT THE STAFF AND PATIENT CARE AND SAFETY. IT SEEMS THAT SOME SURVEYOR HAS MORE CONTROL OVER STAFFING THAN WE DO. ADMINISTRATION WANTS HIGH MARKS ON SATISFACTION SCORES BUT SAFETY IS THROWN OUT THE WINDOW SO MANY TIMES. I FEEL LIKE THE WORD NURSING SHORTAGE IS A WORD USED TO FULL THE PUBLIC. HOW MANY TIMES HAVE STAFF BEING CANCELED OR PUT ON CALL TO FATTEN THE STOCK HOLDERS POCKETS ARE MAKE ADMINISTRATION A BIGGER BONUS AT THE END OF THE YEAR.IF A NURSE GETS SICK SHE IS THROWN OUT LIKE A DIRTY DISH RAG WITH THE REST OF THE TRASH. I HOPE THERE IS A DECENT HOSPITAL OUT THERE WHO REALLY CARES ABOUT THEIR STAFF AND THEIR PATIENTS. I WILL BE A LOYAL EMPLOYEE AND SUPPORTER FOREVER.

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In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.